Transcatheter and Surgical Aortic Valve Replacement in Dialysis Patients: A Propensity-Matched Comparison

Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Patients on Maintenance Dialysis

“…Similarly, in a multicenter study by Allende et al one-year mortality was 44% in dialysis patients compared with 21% in patients with normal renal function 25 . In another study, Kobrin et al found that in dialysis patients, one-year mortality was 40% after TAVR and 36.4% after SAVR 11 . These findings raised the question of whether these high-risk patients do indeed benefit from TAVR.…”

“…Dialysis status has now become a standard element in the TAVR risk prediction tool derived from large-scale data available in the ACC/TVT registry 30, 31 . To our knowledge, only one comparative study has assessed the outcomes of SAVR versus TAVR in dialysis patients 11 . In a propensity-matched analysis, Kobrin et al found no difference in 30-day mortality between dialysis patients who underwent SAVR compared to TAVR (8% vs. 10%, respectively.…”

“…Several studies have shown a substantial intermediate and long-term mortality in dialysis patients with aortic stenosis despite definitive treatment 11, 33 . In the TVT registry, patients undergoing TAVR who were on dialysis had a 41% one-year mortality compared with 24% in the overall TAVR cohort 33 .…”

“…Although the availability of transcatheter aortic valve replacement (TAVR) has expanded access to definitive therapy to a larger population of patients with severe aortic stenosis, utilization in dialysis patients has been debated for a few reasons: (1) Patients with end-stage renal disease were excluded from the pivotal TAVR trials (The PARTNER, and the Medtronic CoreValve trials) 9, 10 . (2) The limited comparative data on transcatheter versus surgical treatment of aortic stenosis in dialysis patients suggested no advantage of TAVR over SAVR 11 . (3) TAVR has been associated with greater total cost compared with SAVR 12, 13 , which may be a limitation to its utilization in a population with very resource intensive disease status 14 .…”

Changes in kidney function among patients undergoing transcatheter aortic valve replacement

“…In patients with advanced CKD or dialysis dependence, studies have shown a higher rate of early and late mortality following TAVR (28,29). Despite having poorer outcomes after TAVR compared with non-dialysis patients, TAVR is comparable with SAVR in ESRD patients on dialysis based on a propensity-matched comparison of all Medicare feefor-service patients undergoing TAVR or SAVR (29). Data on renal function change after TAVR in advanced CKD (nondialysis stage 5 CKD) are limited.…”